Hospitals can easily prevent patients from contracting an infection that still affects 45,000 to 90,000 people per year (Gaynes & Band, 2014). This infection is from a common device used to administer medicine and fluids called a central venous catheter (CVC), also known as a central line. This device is a tube that leads straight to the patient’s heart, which allows doctors to administer medicine to their patients quickly. Because CVCs are so useful, more than five million are inserted by medical professionals each year in the United States (Heffner & Androes, 2015); however, these devices leave patients vulnerable to major bloodstream infections (BSIs) if not cared for properly.
A CVC is a thin tube that runs from the insertion site – typically the neck, chest, or thigh – into a large vein that runs to the heart – the jugular, subclavian, or femoral veins respectively. Access straight to the heart is beneficial because it allows for a quick response to any medicine administered, and it can also be helpful for people who have poor access to peripheral veins. CVCs can stay in much longer than normal IVs, so they are typically used for patients who need medication or fluids over a long period of time. For example, CVCs are used to give chemotherapy since it is given over multiple weeks, but the CVC also helps in this situation because it can protect the patient from the noxious medication that can cause inflammation of their veins. They can also be used to give large amounts of blood to the patient, to take frequent blood samples, or to monitor blood flow.
There are multiple types of catheters that can be placed depending on the length of time it will be used. If the CVC is only meant to be there temporarily, a non-tunneled catheter is typically placed. These catheters can be placed quickly, usually in the neck or chest, using a needle without having to expose any tissues. Non-tunneled catheters have higher rates of infection; however, there is less discomfort and risk associated with them, and they are beneficial in emergency situations since they can be placed quickly (Heffner & Androes, 2015).
Two main types of catheters are used for long term situations (i.e., placed for multiple weeks or permanently): a tunneled catheter and a subcutaneous port. A tunneled catheter is inserted surgically and runs from the entrance, through a tunnel under the skin, and into the vein. These catheters have lower rates of infection compared to non-tunneled catheters (Heffner & Androes, 2015). Lastly, a subcutaneous port is a device that is implanted under the skin of the chest and has a tube which runs to the vein. The port is a small, self-sealing chamber that can be accessed by needle puncture. Subcutaneous ports have the lowest infections rates out of the three catheters described (Heffner & Androes, 2015). They are also beneficial for the patient because they are hidden from view and allow for normal activities such as swimming and showering. Below is a picture of the three main types of catheters used.
Many complications can occur from CVCs including arrhythmias (i.e., catheter placed too far and ends up in heart causing an abnormal heart rhythm), puncturing an artery, or the entrance of air into the blood with the injection (Young, 2014). However, one of the most common complications associated with CVCs is infection. Bacteria or viruses on the patient’s skin or on health care workers’ hands may cause central line infections. It is also possible that the catheter or the injections are contaminated before insertion (Gaynes & Band, 2014). People with central line infections may experience fevers, chills, hypotension, hypothermia, apnea, or bradycardia (Band, 2014; Corliss, Elbaum, & Long, 2015). The insertion site of the catheter may have swelling, redness, smelly discharge, or may be warm to the touch (Corliss et al., 2015). A health provider should confirm the presence of an infection with blood and/or catheter cultures (Band, 2014).
After the infection is detected, the doctor must decide whether they should salvage, exchange, or remove the CVC; the decision depends on the location of the infection and the symptoms it is causing. The patient should also be put on antibiotic therapy for anywhere from two to six weeks depending on the severity of the infection. The patient needs to be monitored closely after treatment to ensure the infection has been cured (Band, 2015). If the infection is not treated, central line infections may lead to death – 31,000 people die every year from BSIs acquired in hospitals, and CVCs are the most common cause of these infections (Gaynes & Band, 2014; Landro, 2011).
A simple checklist has been developed to help prevent central line infections, and it has proven to be very effective. Dr. Peter Pronovost – director of the Armstrong Institute for Patient Safety and Quality and senior vice president for Patient Safety and Quality at Johns Hopkins Medicine – developed a five step checklist for doctors to follow that has been proven to prevent over 70 percent of central line infections in hospitals (Kliff, 2015). The first step is simply for the doctors to wash their hands using either soap and water or an alcohol cleanser. Next, the doctors should wear sterile clothing including a mask, gown, hat, and gloves, and they should completely cover the patient with a sterile drape. Third, the CVC insertion site should be cleaned with chlorhexidine, an antiseptic. Fourth, veins in the arms and legs should be avoided as they have higher chances for infection. Lastly, the CVC should be checked for infection every day and should be removed as soon as it is no longer needed. Dr. Pronovost also suggests that hospital nurses should ensure the doctors follow the checklist before each central line insertion. This checklist can not only reduce central line infections in hospitals by 70 percent, but can also save hospitals an average of a million dollars a year in treatments and care for infected patients (Landro, 2011).
CVCs are very beneficial for many patients. They can help people who need medicine quickly or who do not have adequate access to peripheral veins, and they are used to administer lifesaving medicine, blood transfusions, or chemotherapy. However, the infection rates for these catheters are too high. Central line infections can be prevented. Hospitals must assure its physicians and nurses adhere to simple safety measures and prevent these potentially deadly infections in their patients.
Band, J. D. (2014, October 7). Diagnosis of intravascular catheter-related infections. Retrieved from http://www.uptodate.com/contents/diagnosis-of-intravascular-catheter-related-infections
Band, J. D. (2015, July 21). Treatment of intravascular catheter-related infections. Retrieved from http://www.uptodate.com/contents/treatment-of-intravascular-catheter-related-infections
Corliss, J., Elbaum, D. A., & Long, G. J. (2015). Patient information: Central line infections (the basics). Retrieved from http://www.uptodate.com/contents/central-line-infections-the-basics
Gaynes, R., & Band, J. D. (2014, June 17). Epidemiology, pathogenesis, and microbiology of intravascular catheter infections. Retrieved from http://www.uptodate.com/contents/epidemiology-pathogenesis-and-microbiology-of-intravascular-catheter-infections
Heffner, A. C., & Androes, M. P. (2015, January 9). Overview of central venous access. Retrieved from http://www.uptodate.com/contents/overview-of-central-venous-access
Kliff, S. (2015, July 9). Do no harm: There’s an infection hospitals can nearly always prevent. Why don’t they? Retrieved from http://www.vox.com/2015/7/9/8905959/medical-harm-infection-prevention
Landro, L. (2011, March 28). The secret to fighting infections. Retrieved from http://www.wsj.com/articles/SB10001424052748704364004576131963185893084
Young, M. P. (2014, August 27). Complications of central venous catheters and their prevention. Retrieved from http://www.uptodate.com/contents/complications-of-central-venous-catheters-and-their-prevention